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Psychological Report

Background Information

Luis is a US citizen of Spanish origin; he emigrated from Puerto Rico at the age of 14. Spanish is his native language, but Luis is also very proficient in English. He completed high school and one year of vocational training for skilled machinists. Luis worked as a semi-skilled autoworker, but was laid off 6 months ago. Due to this, Luis had to return to living with his parents. He found a job of pizza delivery person. Luis’s health is within normal limits and he was not reported on any medication.

Luis has an older brother who is studying at college, and a younger sister who is living with Luis and his parents. Luis is dating a woman and says he is going to marry her. Luis’s parents are religious and visit church every week, but Luis only visits church on major holidays. Luis says he has many friends. Luis likes fishing, playing video games and watching sports on TV.

Luis’s reasons for referral are long standing issues of impulsivity and anger. These issues were activated when Luis returned to living with his parents. Luis demonstrates the same behavior patterns to his parents as he had while growing up. In addition, Luis has arguments with his girlfriend and even avoids her sometimes because she makes him angry. Luis says his motivation to do things declined, and he feels he is not himself any more. The question to be answered by the assessment is whether Luis has any disorders or episodes, and what treatment (if any) he should receive to cope with his current issues.

Cognitive and Personality Test Administered

Three tests were administered: Wechsler Adult Intelligence Scale (WAIS-IV), Minnesota Multiphasic Personality Inventory (MMPI-2) and Rorschach test. WAIS-IV is the major clinical instruments for measuring intelligence in older adolescents and adults (Groth-Marnat, 2009). This test is applicable for age range from 16 to 90 years old (Groth-Marnat, 2009). In Luis’s case it was administered to assess his cognitive abilities.

MMPI-2 is one of the most widely researched and used adult psychopathology tests; MMPI-2 allows assessing the patient’s mental state, helps determine the diagnosis and is useful for identifying treatment methods (Nichols, 2011). In Luis’s case, the test was administered in order to assess his personality traits, to identify existing mental issues and deviations, and to recommend optimal treatment.

Rorschach inkblot test is a projective technique which is used to assess personality profile and to identify the likelihood of mental disorders (Groth-Marnat, 2009). In Luis’s case, the test was administered for the purpose of assessing his personality and complementing the results of MMPI-2 in terms of diagnosis.

Clinical Observations

Luis demonstrated cooperativeness, and easily established rapport. He reported that in the night he had sleep issues (had troubles getting asleep and staying asleep). Luis’s responses were sluggish at times, and he sometimes slumped back in the chair.

Luis’s appearance during the assessment was casual; he demonstrated inappropriate affect, fair judgment and insight. His memory was intact, and intelligence was average. Luis’s behavior was friendly and cooperative, but at the same time impulsive and he had poor concentration. Luis’s cognitive processes were normal, but his mood was irritable.

Luis’s mother was diagnosed with depression when they moved from Puerto Rico to the US.

Assessment Results

WAIS-IV Results

 

Subtest

Raw

Score

Scaled

Score

Block Design

8

8

Similarities

9

9

Digit Span

6

6

Matrix Reasoning

8

8

Vocabulary

10

10

Arithmetic

5

5

Symbol Search

7

7

Visual Puzzles

10

10

Information

7

7

Coding

7

7

Letter-Number Seq.

(6)

(6)

Figure Weights

(10)

(10)

Comprehension

(11)

(11)

Cancellation

(9)

(9)

Picture Completion

(7)

(7)

Sum of Scaled Scores

26

26

11

14

77

Verbal

Comp.

Perc.

Rsng.

Work.

Mem.

Proc.

Speed

Full

Scale

 

Scale

Sum of Scaled

Scores

Composite

Score

Percentile Rank

Confidence

Interval

90% of 95%

Verbal Comprehension

26

VCI

93

32

88-99

Perceptual Reasoning

26

PRI

92

30

86-99

Working Memory

11

WMI

74

4

69-82

Processing Speed

14

PSI

84

14

77-94

Full Scale

77

FSIQ

84

14

80-88

 

MMPI-2 Results

Validity and clinical scales Raw Scores
VRIN 8
T/F TRIN 8
F 7
Fs 4
Fp 3
FBS X
L 6
K 17
S 29
1

Hs+5K

6 (15)
2

D

29
3

Hy

24
4

Pd+4K

23 (30)
5

MI

31
6

Pa

10
7

P1+1K

10 (27)
8

Sc+1K

10 (27)
9

Ma+2K

 

20 (23)
0

S1

24
   
   
Harris Lingoes & Si Subscale Raw Scores
D1 14
D2 9
D3 3
D4 7
D5 3
Hy1 2
Hy2 4
Hy3 3
Hy4 2
Hy5 1
Pd1 5
Pd2 2
Pd3 1
Pd4 3
Pd5 7
Pa1 3
Pa2 2
Pa3 1
Sc1 0
Sc2 3
Sc3 2
Sc4 3
Sc5 1
Sc6 2
Ma1 1
Ma2 3
Ma3 2
Ma4 3
Si1 6
Si2 5
Si3 12
   
Content Scales Raw Scores
ANX 12
FRS 8
OBS 3
DEP 17
HEA 5
BIZ 2
ANG 11
CYN 9
ASP 9
TPA 7
LSE 11
SOD 12
FAM 11
WRK 12
TRT 7
   
Content Component Scales Raw Scores
FRS1 1
FRS2 1
DEP1 6
DEP2 5
DEP3 4
HEA1 0
HEA2 0
HEA3 1
BIZ1 1
BIZ2 2
ANG1 5
ANG2 5
CYN1 7
CYN2 4
ASP1 6
ASP2 2
TPA1 2
TPA2 1
LSE1 4
LSE2 4
SOD1 5
SOD2 2
FAM1 7
FAM2 3
TRT1 3
TRT2 1
   
Supplementary Scales Raw Scores
AGGR 10
PSYC 2
DISC 10
NEGE 15
INTR 18
A 17
R 20
Es 35
Do 17
Re 23
Mt 10
PK 17
MDS 3
Ho 25
O-H 10
MAC-R 19
AAS 2
APS 24
GM 39
GF 30
   

Rorschach Test Results

Card/Response Response to inquiry Comments
Card 1:

1.

Look like (ll) a wolf head

 

 

 

 

 

See the eyes (s), white fangs, big ears, ll there may be saliva splattering from its mouth. – these things, dots here. It looks hairy and furry-the grey/black furry edges.

 

 
Card 2

1.

Rocket taking off.

 

 

 

 

 

 

 

2.

A furry face looking from behind the bushes.

(Points to space in center) See, right here.  The red is the fire and stuff from taking off.  I don’t know, I guess the color and shape.  This could be the earth-the black continents here and here.

 

Here, pts to white spaces at top, and nose, pts to space in the center. It looks sad, just the way the eyes are.

 
Card 3

1.

Two people stirring a black pot sitting on a fire.

 

 

 

 

2.

A butterfly in the middle flying over the pot.

They ll women, here are their breasts and they’re standing on their toes, see here (pts at bottom detail). Their hair is up, see their chins and nose. Just the way it looks, the shape of it all.

 

 

The red part, the shape, just fluttering over the fire. I guess the color and shape.

 
Card 4

1.

What’s that thing called, oh yea, ll Sosquatch. It’s huge with big feet.

The color and shape of it.  The dirty furryness. Grey/black the way it looks. Just standing there, waiting to decide where to go next. Because its not moving, just looking off.  
Card 5

1.

Ll a huge bat with its wings down.

Here’s the body (pts to center form) here are the wings.  It’s black. Here’s the head and antennae, the feet. Just the black and shape.  
Card 6

1.

Road kill of a cat.  It’s squashed flat.

Here see the tire marks (pts to faint lines in the center) Here are the whiskers, these lines. I don’t know wear the tail is though. Maybe cut off from the body by the car. The edges and black/grey makes it look furry.  

 

Touches the card as if to pet what he sees as the cat.

 

Card 7

1.

Ll two fists with thumbs up

Pts to top detail, see, here are the closed fists, here are the thumbs. Just the shape.  That’s all Feelings for mother – distant, neutral
Card 8

1.

Wow, pretty colorful. Let’s see, ll animals pulling at another animal.

 

 

 

 

 

.

Here are the animals legs, paws, LL they’re pulling at the skin of another animal. See the bones here (pts to upper middle detail) I guess the white and black shapes. The colors could be different parts of the inside of the animal.  “Pretty gross-just the idea of it all”

 

 

 

 

 

 

 

 

 

 

Turns the card over and looks away.

Card 9

1.

This whole thing ll a girls head with a weird hairdo or some kind of hat.

 

 

 

 

 

 

 

Here are the eyes, (upper white space).  These are tears dropping down her face, (pts to space on either side of lower half of design) She looks like she’s sobbing, her head is shaking like you’d see in a cartoon picture of all the jagged edges. A drawing would be like this to show it’s moving back and forth.  (Doesn’t include the lower third of design)

 

 

 

 

 
Card 10

1.

A water color painting of an under water scene.

All the different colors, shapes attached and detached from one another. Everything ll it’s moving LL seahorses, shape, crabs-legs and shapes, dirt and stuff floating in the water-the colors these don’t ll anything. Holds onto card, staring at it for more time that what was observed with other cards.

 

 

 

Interpretation

WAIS-IV

The results of WAIS-IV indicate that Luis’s intelligence is in the low average range (full-scale IQ score is 84 which is higher than only 14% of the sample). Verbal comprehension and perceptual reasoning scores are 93 and 92 accordingly, which corresponds to the 32th and 30th percentile. These abilities are in the average range. Luis’s working memory and processing speed are particularly low, as WAIS-IV scores for them are 4 and 14 accordingly, which corresponds to the 4th and 14th percentile. Working memory is Luis’s weakness; this means that it is difficult for him to sustain attention, demonstrate mental control and concentrate (Groth-Marnat, 2009). Luis’s processing speed is also weak; this means that he is experiencing difficulties processing visually perceived information, establishing eye-hand coordination and concentrating (Groth-Marnat, 2009).

The discrepancies between VCI and PSI, PRI and PSI, WMI and PSI are large and significant, and therefore it is recommended to use GAI instead of FSIQ for assessing Luis’s intelligence (Groth-Marnat, 2009). There is a possibility of cognitive impairment because PSI score is very sensitive to such impairments. Since Luis’s lowest scores were letter-number sequencing, cancellation and figure weights, it is likely that he has a mild cognitive impairment (Groth-Marnat, 2009). This hypothesis is confirmed by such changes in Luis’s character as irritability, agitation, anxiety, apathy and deficit of attention (Groth-Marnat, 2009).

MMPI-2

MMPI-2 assessment of Luis’s personality is valid and consistent, because VRIN, TRIN, F and Fb scales are within the normal range. Code type of Luis’s profile is 23/32. Luis’s profile demonstrates normal adjustment with slight peaks for depression, hysteria and psychopathic deviate scales, and low levels of paranoia and S1 scales. It is likely that Luis might be having moderate difficulties, but there are no indications of serious pathologies. High score on Hy scale (30) indicates the possibility that Luis has depression.

Luis’s scores for L (lie) and K (defensiveness) scales are moderate. These values point out that Luis has good contact with reality and is capable to produce socially acceptable responses (Nichols, 2011). Luis is also likely to be independent and have good ego strength. Average S score means that Luis have honest answers and was not pretending to seem better as he is.

Hs score is within the normal range, which means that Luis is not prone to hypochondria. High D score indicates that Luis is having a reactive depression, has difficulties concentrating, might be impatient and irritable (this is confirmed by clinical observations and Luis’s complaints). Luis might avoid interpersonal relationships (Nichols, 2011).

Hysteria score is also high; this means that Luis converts his emotional and interpersonal difficulties onto the body, and might be acting out to attract attention and implicitly seek support. Impulsiveness and aggression are characteristic features of such Hy score. This score also means that Luis has a high level of stress (caused by both external factors such as returning back to parents and changing job and internal factors related to cognitive abilities).

Pd score is somewhat elevated, but this might be due to Hispanic origin of Luis – mild elevations for minority participants often mean that they believe the common rules and attitudes are unfair and discriminatory (Nichols, 2011). Elevations of Pd score also point out at aggressiveness and self-centeredness. Luis might be feeling guilt for his previous behavior (scales 2 and 4 are both elevated).

Luis’s masculinity-femininity score is within the normal range, which means that Luis is comfortable with existing gender roles. Paranoia score is slightly below average; this means that Luis has a balanced personality and generally normally accepts the changes of life. Psychasthenia, schizophrenia and hypomania scores are within the normal range. Luis’s social introversion is slightly below average, which means that he needs to be around other people and needs social approval (Nichols, 2011). These tendencies might be used to reinforcing therapeutic effect.

Luis’s profile is 23/32, with elevated scale 4, which indicates that Luis might have an affective disorder with antisocial and aggressive components (Nichols, 2011). Luis’s main personality dynamic is denial (Nichols, 2011).

Symptomatic scales also confirm the hypothesis about depression and high level of stress: Luis has elevated ANX (general anxiety, worries, insomnia, concentration issues), DEP (depression, loss of interest in life, hopelessness and helplessness), ANG (irritability, difficulty controlling anger) and LSE (low self-confidence, negative feelings regarding self) scales (Nichols, 2011). FAM score is elevated, which indicates that most external problems relate to family issues.

Supplementary scales show that Luis has high INTR score, which means that he has a predisposition for negative affects and for avoiding social experience (Nichols, 2011). PK scale is also elevated; this points out at high emotional distress, anxiety, depression, and indicates that there might have been traumatic events which affected Luis’s state.

Rorschach

Luis might have a predisposition for paranoia has he saw an animal face on card 1 (Rose, Kaser-Boyd & Maloney, 2001). He might experience troubles relating to people because he did not identify human figures on card 2 (Rose, Kaser-Boyd & Maloney, 2001). He also has a rather cautious and somewhat hostile perception of his father (due to the description of card 4) (Rose, Kaser-Boyd & Maloney, 2001). Luis has a predisposition towards negative thinking and perception as he saw a killed cat on card 6. Luis’s feelings for mother are neutral and distant, as he did not identify women or human objects on card 7. Luis’s core mental abilities are intact, as he identified animals on card 8 (Rose, Kaser-Boyd & Maloney, 2001). His organizational abilities are also intact as he saw water life on card 10 (Rose, Kaser-Boyd & Maloney, 2001). Overall, the results of Rorschach test indicate that Luis is only likely to have minor signs of disorder.

Summary

Luis’s intellectual abilities are in the low average range; his working memory and processing speed are however rather low compared to verbal comprehension and perceptual reasoning. There is a possibility that Luis has a mild cognitive impairment. There is also a possibility that Luis’s depressed state and anxiety affected his cognitive abilities. It is recommended to perform more detailed assessment of Luis’s cognitive abilities and health condition in order to check this hypothesis.

Luis’s working memory and processing speed are low, and this situation might affect his mental state as well as personality. Luis has a reactive depression which is further affected by endogenous factors (possibly, it is the deterioration of cognitive abilities). Luis’s state is characterized by high level of stress, high need for social approval combined with the desire to isolate oneself from the society and to avoid social experience, denial of emotional challenges and high level of aggression and irritability. It is likely that Luis has an affective disorder or episode with angry and antisocial manifestations.

Diagnosis

Axis I                          310.1 Personality Change due to mild cognitive impairment, aggressive type OR 293.83 Mood Disorder due to mild cognitive impairment

Axis II                        301.83 Borderline Personality Disorder

Axis III                       331.83 Mild Cognitive Impairment

Axis IV                       problems with primary support group (conflicts with parents and girlfriend), occupational problems (change of job), housing problems (relocation)

Axis V Current           68

Recommendations

It is recommended to combine treatment aimed at improving Luis’s cognitive abilities and depression treatment. Luis currently does not present a danger to himself, so it is recommended to schedule counseling sessions. Luis has a moderate level of depression, so he is likely to be motivated and collaborate with the psychotherapist (Goldfinger & Pomerantz, 2009). It is also reasonable to consider prescribing antidepressants to reduce Luis’s level of stress. A balanced schedule of exercising and mentally stimulating activities is recommended to improve Luis’s cognitive abilities. If the hypothesis of mild cognitive impairment is confirmed, it might be necessary to prescribe Rivastigmine or similar drugs in order to prevent the deterioration of cognitive functions.

Since Luis has a high hysteria score, he might become manipulative and verbally aggressive (Groth-Marnat, 2009). It is recommended to set short-term goals and praise Luis’s achievements to increase the effectiveness of counseling sessions. Establishing therapeutic relationship is very important, because due to high score on Pd scale, Luis might resist such relationship, but at the same time, he needs social approval and support.

 

 

 

 

References

Goldfinger, K., & Pomerantz, A. M. (2009). Psychological assessment and report writing. Thousand Oaks, CA: Sage Publications.

Groth-Marnat, G. (2009). Handbook of psychological assessment. Hoboken, NJ: John Wiley & Sons, Inc.

Nichols, D. S. (2011). Essentials of MMPI-2 assessment. New York: John Wiley & Sons, Inc.

Rose, T., Kaser-Boyd, N., & Maloney, M. P. (2001). Essentials of Rorschach assessment. New York: John Wiley& Sons, Inc.